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Vantage Medicare Advantage

Quality Assurance

Transition of Care Issues

You may be able to get a temporary supply

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your doctor about the change in coverage and figure out what to do.

To be eligible for a temporary supply, you must meet the two requirements below:

  1. The change to your drug coverage must be one of the following types of changes:
    • The drug you have been taking is no longer on the plan's Drug List
    • -- or --
    • The drug you have been taking is now restricted in some way
  2. You must be in one of the situations described below:
For those members who were in the plan last year and are not in a long-term care facility:
  • We will cover a temporary supply of your drug one time only during the first 90 days of the calendar year. This temporary supply will be for a maximum of a 30-day supply, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.
For those members who are new to the plan and are not in a long-term care facility:
  • We will cover a temporary supply of your drug one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of a 30-day, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.
For those who have been a member of the plan for more than 90 days, and are a resident of a long-term care facility and need a supply right away:
  • We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

Our plan will cover a temporary 31-day supply of non-formulary drugs (unless the prescription is written for fewer days) for current members with level of care changes.

To ask for a temporary supply, call Member Services Toll-Free at (866) 704-0109.

During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. Perhaps there is a different drug covered by the plan that might work just as well for you. Or you and your doctor can ask the plan to make an exception for you and cover the drug in the way you would like it to be covered. The sections below tell you more about these options.

If you need medical attention or need to fill prescriptions after your coverage begins, but have not received your ID card, please have your medical provider or pharmacist call Vantage at 1-318-361-0900, Toll-Free 1-888-823-1910 or TTY 711 (for the hearing impaired).

Medication Therapy Management Program

The Medication Therapy Management (MTM) program is not a benefit but is a service we offer at no cost. Our MTM program helps you and your doctor better manage your medications. MTM can help find any possible errors or gaps in your care by:

  • Lowering the risk of medication errors, especially if you have chronic conditions, take many medications, or see multiple doctors
  • Giving information on proven medical practices to help you and your doctor decide the most effective treatment
  • Helping you understand your condition and medications, so you can take an active role in taking care of your health

By participating in the MTM program, we can help you make sure your medications are working for you, may help you find lower cost options, and answer any questions or concerns you may have about your medications.

How do I qualify for MTM?

Vantage determines eligibility monthly by looking at your pharmacy and medical claims. Once you qualify, you are automatically enrolled in the program for the rest of the calendar year.

2022 MTM Eligibility Criteria

To qualify for the MTM program, you must meet all three of the following criteria:

  • You have three of the following conditions:
    • Congestive heart failure, diabetes, dyslipidemia, hypertension, COPD, anemia, chronic noncancer pain, AND
  • You are taking eight or more chronic/maintenance (covered Part D) medications, AND
  • You are likely to spend more than $4,696 in 2022 on prescription drug costs (includes amounts paid by both you and Vantage)
  • OR
  • You are enrolled in a Drug Management Program that helps you better manage and safely use your medications such as those used for pain
How do I get started?

Within 60 days of being enrolled, you will receive a Welcome Letter by mail. This letter will include general information about the MTM program, provide instructions on how to contact the MTM program, and how to opt-out. At least once a year, all eligible members will be offered a one-on-one Comprehensive Medication Review (CMR) with a Vantage clinical pharmacist or licensed pharmacy intern under the direct supervision of a pharmacist. You may call the number provided to schedule an appointment to complete your annual CMR. We will also be reaching out to you by phone to schedule an appointment or complete the CMR during the time of the call. We encourage all eligible members to complete a CMR every year.
During the CMR, a pharmacist or pharmacy intern will guide you through a comprehensive review of your entire medication profile (including prescriptions, over the counter medications (OTCs), herbal therapies, dietary supplements, and samples). Medications are reviewed for opportunities to improve medication adherence, reduce prescription drug costs, or any problems that may be preventing you from taking your medications as prescribed. Our goal is to help you get the most from your prescription benefits and improve your medication experience. Disease-specific goals of therapy are discussed with you, as well as any member-specific questions. Most calls take about 20 to 30 minutes to complete.
After the CMR, you will get a written summary of the consultation in the mail within 14 days. The summary has a medication action plan that has steps you should take to ensure your desired health outcomes are met. You will also get a personal medication list that will include all the medications you are taking, how to take them, and why you take them. This can help you keep track of your medications, clearly understand why you take them, and how to use them the correct way. It can also be helpful when meeting with your doctor or pharmacist.

If you would like a copy of a blank personal medication list please click here.
If you would like a copy of a blank medication action plan please click here.

The pharmacist will work collaboratively with other Vantage Health Plan clinical program team members and providers to recommend any appropriate medication changes and ensure they are aware of important information discussed during the review. Your doctor will decide whether to consider our recommendations. Your prescription medications will not change unless you and your doctor decide to change them.

Additionally, all eligible members will receive quarterly Targeted Medication Reviews (TMR). TMRs look for specific or potential medication-related problems such as medication adherence, new drug therapy problems, drug-drug interactions, etc. After each TMR, we may send suggestions to your doctor about prescriptions that may be safer or a better alternative. As always, your doctor will decide whether to consider our suggestions. We may also contact you with suggestions about your medications.

In addition, our MTM program is a referral source for our members enrolled in Case Management, Disease Management, VMAP (Vantage Medication Adherence Program), and SNP-enrolled. For members who also meet our internal criteria for opioid overutilization risk, we focus on improving education and awareness of the risks of opioids, the use of CDC guideline approved pain therapies, Narcan use and overall harm reduction. We communicate the results of the MTM services to other interdisciplinary care managers who may be assisting these same members with other healthcare needs.

How can I get more information about the MTM Program?

If you would like more information or have questions about the MTM Program, please contact the Vantage MTM Department at 1-844-657-7825 (TTY 711). Representatives are available Monday through Friday, 8 a.m. to 5 p.m. CST. Participation is voluntary and does not affect Medicare coverage for drugs covered under Medicare. You can opt out of the MTM program or any individual MTM service at any time by calling 1-844-657-7825 (TTY 711). If you previously told us that you did not want to participate in the MTM program but have changed your mind and now wish to participate, please contact us at the above number.

Information for Safe Medication Disposal

Medications that are safe for you may be harmful to someone else. Unneeded, unused, and expired medications should be disposed of as soon as possible. This is especially important for controlled substance medications to avoid accidental poisoning, misuse, or abuse. The best way to dispose of most types of medications is to take them to a local Drug Take Back Site or Program.

Drug Take Back Sites

The U.S. Drug Enforcement Administration (DEA) and its partners collect and safely dispose of medications as a service to communities. To find drug take back sites nearest you, visit the website below and enter your location: https://apps2.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e2s1 You can also call your pharmacy or local law enforcement (non-emergency number) for a safe medication disposal site near you. Some pharmacies offer on-site medicine drop-off boxes, mail-back programs, and other ways to help you dispose of your unused medications.

Drug Take Back Programs

The U.S. Drug Enforcement Administration (DEA) sponsors National Prescription Drug Take Back Days in communities nationwide, usually in April and October. Many communities also have their own drug take back programs. Local Law Enforcement officials and pharmacies are a good source of information on Take Back Days. More information is available online at:

How to Dispose of Medicines at Home

When a take back option is not readily available, two options of disposing medications at home are:

More information on the safe disposal of medications is available from the U.S. Department of Health and Human Services online at: www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html. Other options may be available for safe disposal of medications, such as Disposal Packets and addressed envelopes for mailing. Ask your pharmacist or other health care provider for more information.

This page was last updated:3/16/2022

Vantage Health Plan (Vantage) is an HMO with a Medicare contract. Enrollment in Vantage depends on contract renewal.

This information is not a complete description of benefits. Call 1-888-823-1910 (TTY users call 711) for more information.